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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343604900
Report Date: 02/14/2020
Date Signed: 02/14/2020 01:42:36 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:4TH R - PHOEBE HEARSTFACILITY NUMBER:
343604900
ADMINISTRATOR:NOLLER, CHRISTINEFACILITY TYPE:
840
ADDRESS:1410 60TH STREETTELEPHONE:
(916) 277-3840
CITY:SACRAMENTOSTATE: CAZIP CODE:
95819
CAPACITY:170CENSUS: 11DATE:
02/14/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Sandra DelgadilloTIME COMPLETED:
02:00 PM
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Licensing Program Analysts (LPAs) Marea Behvand met with Site Coordinator Sandra Delgadillo for the purpose of an unannounced case management inspection. Licensee requested to increase from a capacity of 170 school age children to 200 school age children.

A health and safety inspection was conducted in all areas accessible to children. The indoor and outdoor activity space was not measured due to facility being located on a school site.

Director was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form.

An exit interview was conducted and in the areas that were evaluated, no deficiencies were observed at the time of the inspection. A Notice of Site Visit was provided and should remain posted for 30 days for parental review.

Effective today, February 14, 2020, the facility has been approved for maximum capacity of 200 school age children.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Marea BehvandTELEPHONE: (916) 216-7793
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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